Definition
Esophagitis refers to any inflammation, irritation, or swelling of the esophagus. The esophagus is the tube that leads from the back of the mouth to the stomach. It may be acute or chronic.
Risk Factors
Esophagitis is most commonly results from recurrent reflux of gastric contents into the distal esophagus. Reflux may result from:
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- Incompetent lower esophageal sphincter
- Gastric or duodenal ulcers
- Prolonged nasogastric intubation
Pathophysiology
- Gastric hydrochloric acid from reflux of gastric juices alters the pH of the esophageal mucosa, permitting mucosal protein to be denatured; proteolytic properties of pepsin in gastric secretions are enhanced in altered pH, leading to further damage.
Assessment/Clinical Manifestations/Signs and Symptoms
- Heartburn, acid regurgitation and belching
- Dysphagia
- Esophageal pain, possibly radiating to the arms, neck, back,jaw and substernal area
- Pain may be precipitated by increased abdominal pressure, as can occur from bending, straining, obesity or pregnancy.
Laboratory and diagnostic study findings:
- Esophagogastroduodenoscopy may reveal irritated, inflamed areas with possible eroded areas. Brushing and biopsy results can exclude cancer of the esophagus.
- Twenty-four-hour pH monitoring detects decreased pH of gastric contents.
- Esophagoscopy and barium swallow detect anatomic or functional derangements of esophagus secondary to acid erosion.
Nursing Management
- Promote adequate nutritional intake. Instruct the client to:
- Eat small, frequent meals of mostly bland foods
- Chew food thoroughly before swallowing
- Drink fluids to aid swallowing and food passage down the esophagus.
- Refrain from laying down after eating
- Avoid eating within 3 hours of bedtime
- Assess all vomitus for content, note undigested food and blood (i.e. coffee-ground or bright red appearance)
- Maintain integrity of the oral mucosa.
- Minimize pain.
- Instruct the client to avoid irritants. Advise the client to elevate head of his bed with blocks to help minimize reflux.
